Freiberg's disease

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Freiberg's disease

 [fri´bergz]
osteochondrosis of the head of the second metatarsal bone.

osteochondritis

Orthopedics Inflammation of bone and joint surfaces–usually aseptic; note: A legacy of the German school of medicine was eponymic immortalization of osteochondritis in each joint
Osteochondritis eponyms
Freiberg's disease–metatarsal head
Haglund's disease–calcaneus
Köhler's disease–tarsal-navicular bones
Legg-Calve-Perthes disease–femoral head
Osgood-Schlatter disease–tibial tubercle
Panner's disease–humeral head
Sinding-Larsen-Johannson disease–patella
Thiemann's disease–metacarpal and metatarsal bones
Wegner's disease–osteochondritis with epiphyseal separation–congenital syphilis

Freiberg's disease

osteochondritis (disturbance of bone and cartilage formation) of the head of the metatarsals (especially the second). Aetiology is unknown: both traumatic and vascular causes have been suggested. Most common in athletic girls aged 10-15. Presents with pain and local tenderness. Changes may not be evident initially on X-ray, but can be visualized on MRI. (First described in 1914 by Albert Freiberg, American surgeon.)
Freiberg's disease epiphyseal ischaemic (aseptic) necrosis of second (or third or fourth) metatarsal head; form of crushing apophysitis/osteochondritis, particularly affecting girls aged between 12 and 15 years; characterized by local swelling and pain exacerbated by movement (especially metatarsophalangeal joint dorsiflexion); treatment includes non-steroidal anti-inflammatory drugs and immobilization in order to minimize distortion of affected metatarsal head (see Table 1); late presentations may require surgery
Table 1: The pathology of Freiberg's infraction
StageFeature
IA fissure develops in the epiphysis due to localized ischaemia of bone
IISubchondral fracture with some local bone resorption leads to collapse of the dorsal central portion of the affected metatarsal head, alteration in the contour of the metatarsal head and a slight increase in the joint space
IIIFurther deformation and collapse of the metatarsal head, with osteolysis and flattening of the metatarsal head
IVFragmentation of the medial and lateral parts of the affected metatarsal head, with joint incongruence and permanent deformity
VAdvanced degenerative arthrosis due to ongoing flattening of the metatarsal head and articular destruction; the base of the proximal phalanx becomes irregular with osteophyte formation, narrowing of the joint space and hypertrophy of the metatarsal head